[High quality and restricted resources--a contradiction in terms?]

The aim of quality management is to optimize the quality of care under given circumstances, which include the provided resources. If these resources no longer suffice, a deterioration of the achievable quality will follow. This could be avoided by 1) recognizing and eliminating unnecessary or deficient health services, 2) excluding health services from funding when adequate scientific proof of effectiveness is lacking, and 3) modifying the definition of the level of quality to be achieved. Outcome quality of health care is measured, on the one hand, by prevention of avoidable mortality and morbidity and, on the other hand, by improvement of quality of life and patient satisfaction. Methodologically, it is difficult to determine which part of the quality of life and of patient satisfaction is to be attributed to private life style. Since the evidence for effects on quality of life and patient satisfaction is often worse than for mortality and morbidity, there is the risk that they will become increasingly less relevant when defining the quality that is to be achieved for the community of the insured. In order to prevent this from happening unnoticed, measurements of the outcome quality of care with the indicator group mortality, morbidity, quality of life and patient satisfaction need to be intensified.